Updates to the ICD-10 code set normally occur annually and become effective on October 1st. Due to “COVID-19 being declared a pandemic by the World Health Organization” and “the urgent need to capture the reporting of this condition in our nation’s claims and surveillance data”, the CDC has announced that the official effective date of the new diagnosis code “U07.1, COVID-19” will be moved up to April 1, 2020.  According to the CDC, “this off-cycle change is unprecedented” and is being done via an exception found “under the National Emergencies Act Section 201 and 301”.

Due to the fluidity of the circumstances, there may be further changes or updated guidance on the use of this code, however, interim coding guidance can be found on this CDC page.

At the time of writing, the exact language of changes becoming effective can be found in this document.

ICD-10 EMR Updates

Be sure to update your EMR’s ICD-10 library, applicable code sets, and favorites to include the code for increased efficiency. Be sure not to submit the new code for dates of service prior to the effective date unless instructed to by a specific payer. Most EMR’s allow you to set an effective date which helps to prevent accidentally doing so and the resulting denials.

If you need assistance in adding the new code to your practice’s Electronic Medical Records (EMR) / Electronic Practice Management (EPM) system, please don’t hesitate to contact us for a quote. It is usually quick and therefore inexpensive, in most systems.

Denial and Rejection Monitoring

While payers who require ICD-10 codes, should be prepared for and able to accept the new code immediately, it’s not uncommon to run into clearinghouse or payer-specific issues just after a change. Because of this, it’s extremely important to closely monitor and ensure payers are correctly processing claims containing new codes.

Additional COVID-19 Coding Resources

AHIMA and AHA FAQ on ICD-10-CM Coding for COVID-19

AAPC – Coronavirus: What Every Medical Coder Needs to Know

Here it is ladies and gentlemen, the secret to success… Employees who CARE

Many practices realize that employees are important to the equation. Some try to have potlucks and happy hours to build engagement. Though this is taken slightly out of context, the adage alcohol won’t fix your problems holds true. Having a happy hour won’t make your employees care. If the physicians and managers show that they care and are engaged during a happy hour, it may help change the culture. In this case, it’s not the happy hour itself changing the culture.

Before everyone stops reading and dismisses me for not saying that training, reports, or policies are the determinants, here are three real world scenarios I frequently see to support this assertion:

1. Most would agree that cash collections (co-pays, coinsurance, balances, etc.) are very important for success. I’ve seen numerous practices attempt to implement hardcore policies, monitoring, writing employees up, etc. for failing to collect, but the practices with the highest collection rates (comparatively), are those where the front office employee doesn’t feel obligated to collect for fear of reprimand. They do so because they are personally committed to the provider and practice (they care). Regardless of policies and reports, employees who want to get away with things know the tricks to do so. So when that front office employee is having a “blah” day or doesn’t “feel like” dealing with a difficult patient and know no one is looking; only one type of employee will consistently collect; because they care. Similarly, consider when a patient presents with new insurance and the front office can’t get it to verify, while having a line of patients. The front office person who doesn’t care will often just hope the information was correct and leave it up to billing if it is denied. The front office who cares will take further action almost every time. This is because they care that a denial affects the practice and the patient.
2. A medical biller who cares spots a trend while working denials and if they can’t figure it out, they take the time and initiative to try to figure out the problem or bring it to a supervisor. Employees that don’t care will repeatedly “work” the same claim repeatedly. This often goes unseen by leadership because from a distance the employee is on the phone with a payer and appears to be productive. However, at the end of the day, it’s just an appearance. In addition, very few practices have detailed/accurate reporting in place to accurately measure and compare productivity. Most practices also trust their employees and are therefore quick to write off money, when the employee who cares would have fought for it.
3. Similar to the first two examples, a medical assistant who doesn’t care may frequently “forget” to call back patients with lab results or call in prescriptions. They also frequently appear insincere or disengaged to patients. These are very evident to patients and can severely damage the reputation of a practice (and rightfully so.) A medical assistant who cares can leave such a positive impression with a patient that it can completely reverse/negate even a less than favorable experience with the physician.
4. Bonus example: If a manager or physician doesn’t care, most of the employees are likely not to care; it’s downhill from there.

Again, this is not the only factor that will determine the success of a practice, but without this secret ingredient, at best success will be mediocre and short-lived.

If you’d like to learn more, please stay tuned as I’ll surely be posting more detailed and actionable articles on the subject, including building and fostering a culture of caring.